Nevin Manimala

Ann Surg Oncol. 2022 Apr 11. doi: 10.1245/s10434-022-11700-3. Online ahead of print.

ABSTRACT

BACKGROUND: This study analyzed the long-term survival after pathological complete response (pCR) with and without nodal metastases and associated recurrence following multimodal treatment of esophageal cancer. The recurrence pattern after pCR is of importance for different postoperative surveillance strategies.

METHODS: A cohort of 890 patients with esophageal cancer received neoadjuvant therapy followed by transthoracic esophagectomy. Only patients with pCR of the primary tumor with and without nodal metastasis were analyzed. A clinicopathological database was set up and completed with long-term follow up information on recurrent disease.

RESULTS: The specimen of 201 patients (23%) demonstrated pCR, 84% without (ypT0N0) and 16% with residual nodal disease (ypT0N+). For ypT0N0 patients, the 5-year overall survival was significantly higher than for patients with metastatic nodes (77% vs. 24%) (p < 0.0001). Sixty-eight percent of patients had no evidence of tumor recurrence, whereas 32% had proven relapse. For patients with and without tumor recurrence, 5-year survival rates were 14% and 93%, respectively (p < 0.0001). For patients with recurrent disease, median survival time was 27 for locoregional, 44 for distant, and 24 months for combined recurrence (p = 0.302). In the multivariable Cox-regression analysis, node-positive disease predicted both locoregional and metastatic recurrence.

CONCLUSIONS: Pathological CR offers long-term survival in patients without nodal metastases but outcome significantly deteriorates with the presence of nodal metastases. Follow-up recommendations may therefore be adopted in patients with pCR. Furthermore, “watch-and-wait” surveillance strategies with suspected clinical complete response have to be considered with caution.

PMID:35403919 | DOI:10.1245/s10434-022-11700-3

World J Surg. 2022 Apr 11. doi: 10.1007/s00268-022-06537-6. Online ahead of print.

ABSTRACT

BACKGROUND: Intraoperative PTH (ioPTH) monitoring has become widely accepted in the era of minimally invasive parathyroidectomy (MIP). The purpose of this study was to evaluate the need for ioPTH during parathyroidectomy in patients with positive preoperative imaging.

METHODS: The charts of patients who underwent parathyroidectomy at three tertiary centers between the years 2012 and 2021 were retrospectively reviewed. Patients were defined as MIP candidates with either concordant preoperative imaging or a single positive imaging. Patients with negative or discordant imaging, concomitant thyroidectomy, or previous neck surgery were excluded.

RESULTS: Of a total of 1013 patients who underwent parathyroidectomy, 535 (52.8%) were defined as MIP candidates and were included in the statistical analysis. Surgical success was achieved in all patients. A single adenoma that corresponded to the preoperative imaging was identified and resected in 517 (93.8%) patients. In only 18 (3.3%) patients, the ioPTH correctly changed the operative management where additional pathologic glands were identified and excised. Patients with additional lesions were significantly more likely to have decreased index adenoma size as indicated either by preoperative imaging or by intraoperative findings (15.5 ± 6.6 vs. 8.3 ± 2.5 mm, p < 0.001). None of the patients with an adenoma size greater than 13 mm had an additional pathologic gland.

CONCLUSIONS: Our findings suggest that the routine use of ioPTH in MIP candidates may be omitted in patients with an index adenoma greater than 13 mm, even with only a single positive preoperative imaging study, without compromising surgical success.

PMID:35403873 | DOI:10.1007/s00268-022-06537-6

Arch Orthop Trauma Surg. 2022 Apr 11. doi: 10.1007/s00402-022-04423-3. Online ahead of print.

ABSTRACT

INTRODUCTION: Although non-fracture-related syndesmotic injuries of the ankle are relatively rare, they may lead to poor clinical outcome if initially undiagnosed or managed improperly. Despite a variety of literature regarding possibilities for treatment of isolated syndesmotic injuries, little is known about effective applications of different therapeutic methods in day-to-day work. The aim of this study was to assess the current status of the treatment of isolated syndesmotic injuries in Germany.

MATERIALS AND METHODS: An online-questionnaire, capturing the routine diagnostic workup including clinical examination, radiologic assessment and treatment strategies, was sent to all members of the German Society of Orthopedic Surgery and Traumatology (DGOU) and Association of Arthroscopic and Joint Surgery (AGA). Statistical analysis was performed using Microsoft excel and SPSS.

RESULTS: Each question of the questionnaire was on average answered by 431 ± 113 respondents. External rotation stress test (66%), squeeze test (61%) and forced dorsiflexion test (40%) were most commonly used for the clinical examination. In the diagnostic workup, most clinicians relied on MRI (83%) and conventional X-ray analysis (anterior-posterior 58%, lateral 41%, mortise view 38%). Only 15% of the respondents stated that there is a role for arthroscopic evaluation for the assessment of isolated syndesmotic injuries. Most frequently used fixation techniques included syndesmotic screw fixation (80%, 42% one syndesmotic screw, 38% two syndesmotic screws), followed by suture-button devices in 13%. Syndesmotic screw fixation was mainly performed tricortically (78%). While 50% of the respondents stated that syndesmotic screw fixation and suture-button devices are equivalent in the treatment of isolated syndesmotic injuries with respect to clinical outcome, 36% answered that syndesmotic screw fixation is superior compared to suture-button devices.

CONCLUSIONS: While arthroscopy and suture-button devices do not appear to be widely used, syndesmotic screw fixation after diagnostic work-up by MRI seems to be the common treatment algorithm for non-fracture-related syndesmotic injuries in Germany.

PMID:35403865 | DOI:10.1007/s00402-022-04423-3

Arch Orthop Trauma Surg. 2022 Apr 11. doi: 10.1007/s00402-022-04434-0. Online ahead of print.

ABSTRACT

INTRODUCTION: Osteoporotic vertebral fractures are a major healthcare problem. Vertebral cement augmentation (VCA) is frequently used as a minimally invasive surgical approach to manage symptomatic fractures. However, there is a potential risk of adjacent segment fracture (ASF), which may require second surgery. The addition of transcutaneous screw-fixation with cement augmentation superior and inferior to the fracture [Hybrid transcutaneous screw fixation (HTSF)] might represent an alternative treatment option to reduce the incidence of ASF.

MATERIALS AND METHODS: We retrospectively compared surgery time, hospital stay, intraoperative complication rate and the occurrence of ASF with the need for a surgical treatment in a cohort of 165 consecutive patients receiving either VCA or HTSF in our academic neurosurgical department from 2012 to 2020. The median follow-up was 52.3 weeks in the VCA-group and 51.9 in the HTSF-group.

RESULTS: During the study period, 93 patients underwent VCA, and 72 had HTSF. Of all patients, 113 were females (64 VCA; 49 HTSF) and 52 were males (29 VCA; 23 HTSF). The median age was 77 years in both groups. Median surgery time was 32 min in the VCA-group and 81 min in the HTSF-group (p < 0.0001). No surgery-related complications occurred in the VCA-group with two in the HTSF-group (p = 0.19). ASF was significantly higher in the VCA-group compared to HTSF (24 [26%] vs. 8 [11%] patients; p < 0.02). The proportion of patients requiring additional surgery due to ASF was higher in the VCA-group (13 vs. 6%), but this difference was not statistically significant (p = 0.18). Median hospital stay was 9 days in the VCA-group and 11.5 days in the HTSF-group (p = 0.0001).

CONCLUSIONS: Based on this single-center cohort study, HTSF appears to be a safe and effective option for the treatment of osteoporotic vertebral compression fractures. Surgical time and duration of hospital stay were longer in the HTSF-group, but the rate of ASF was significantly reduced with this approach. Further studies are required to ascertain whether HTSF results in superior long-term outcomes or improved quality of life.

PMID:35403864 | DOI:10.1007/s00402-022-04434-0

Rheumatol Int. 2022 Apr 11. doi: 10.1007/s00296-022-05112-5. Online ahead of print.

ABSTRACT

Since the COVID-19 pandemic started, there have been changes in clinical practice to limit transmission, such as switching from face-to-face to remote consultations. We aimed to study the influence of technical factors on remote consultations in our experience during the pandemic. 12 clinicians completed data collection forms after consultations, recording the technology used (video vs phone); technical problems encountered; discharge or subsequent appointment status; and technical aspects of the consultation process using 0-10 numerical rating scales (NRS) (Time Adequate; Relevant History; Physical Exam; Management Plan; and Communication Quality). Data were collated on an MS Access 2016 database and transferred to SPSS version 25 for statistics. Of 285 forms valid for analysis, 48 (16.8%) had video consultations. Of 259 forms with technical problems data recorded, 48 (18.5%) had a technical problem. Video patients were significantly younger (mean 49.3 vs 61.3 years, p < 0.001), had higher scores on Physical Exam scale (mean 4.0 vs 2.6, p < 0.001), but had no significant difference on Management Plan scale (7.3 vs 7.2). Those with technical problems were more common among video consultations (33.3% vs 15.4%, p = 0.005), had lower scores on Time Adequate scale (7.7 vs 8.7, p < 0.001) and Communication Quality scale (7.1 vs 8.4, p < 0.001), but had no significant difference on Management Plan scale (7.3 vs 7.2). The strongest correlation of Management Plan scale was with Communication Quality scale (Rho = 0.64). Of the NRS, a 1-point reduction in scores on Management Plan scale was the strongest predictor of subsequent face-to-face appointment (Odds Ratio 1.88, 95% CI 1.58-2.24), and this remained an independent predictor in multivariate analysis (adjusted OR 1.90, 1.57-2.31). Having a technical problem was inversely associated with the outcome of a subsequent face-to-face appointment (OR 0.17, 0.04-0.74), and this remained significant after adjustment for Management Plan in multivariate analysis (adjusted OR 0.09, 0.12-0.54). Video patients were younger suggesting a preference for video amongst younger patients. Although technical problems were more common with video, having a video consultation or a technical problem had no significant impact on management plan. Scoring lower on the Management Plan scale was the strongest predictor of, and independently associated with, requesting a subsequent face-to-face appointment. The inverse relationship of technical problems with subsequent face-to-face appointment request will need validation in further studies.

PMID:35403853 | DOI:10.1007/s00296-022-05112-5

Int J Numer Method Biomed Eng. 2022 Apr 11:e3601. doi: 10.1002/cnm.3601. Online ahead of print.

ABSTRACT

This article presents an effort towards building an artificial intelligence (AI) assisted framework, coined ReconGAN, for creating a realistic digital twin of the human vertebra and predicting the risk of vertebral fracture (VF). ReconGAN consists of a Deep Convolutional Generative Adversarial Network (DCGAN), image-processing steps, and finite element (FE) based shape optimization to reconstruct the vertebra model. This DCGAN model is trained using a set of quantitative micro-computed tomography (micro-QCT) images of the trabecular bone obtained from cadaveric samples. The quality of synthetic trabecular models generated using DCGAN are verified by comparing a set of its statistical microstructural descriptors with those of the imaging data. The synthesized trabecular microstructure is then infused into the vertebra cortical shell extracted from the patient’s diagnostic CT scans using an FE-based shape optimization approach to achieve a smooth transition between trabecular to cortical regions. The final geometrical model of the vertebra is converted into a high-fidelity FE model to simulate the VF response using a continuum damage model under compression and flexion loading conditions. A feasibility study is presented to demonstrate the applicability of digital twins generated using this AI-assisted framework to predict the risk of VF in a cancer patient with spinal metastasis. This article is protected by copyright. All rights reserved.

PMID:35403831 | DOI:10.1002/cnm.3601

J Sep Sci. 2022 Apr 11. doi: 10.1002/jssc.202200062. Online ahead of print.

ABSTRACT

Codonopsis Radix, a popular food homology medicine, is widely used in clinical traditional Chinese medicine and food supplement, raw products and three types of processed products are the main form of decoction pieces in China. However, there is no scientific basis for comprehensive chemical characterization of raw and three types of processed products. Herein, we investigated qualitatively and quantificationally secondary and primary metabolites in raw Codonopsis Radix and three types of processed products by metabolomics and glycomics employing multiple chromatography-mass spectrometry technology combined with chemometric analysis further to look for differential compounds and propose the processing-induced chemical mechanisms. The results indicated Codonopsis Radix became dark-colored and smell of burnt incense odor after processing. Principal component analysis demonstrated that secondary metabolome and glycome were significant altered between raw and processed products, and 36 differential secondary metabolites and 11 differential primary metabolites were finally screened through orthogonal partial least-squares-discriminant analysis. The main types of compounds are alkaloids, terpenoids, glycosides, amino acids, monosaccharides, oligosaccharides and furfural derivatives. Meanwhile, Chemical mechanisms could be involved, including oxidation, glycosidic hydrolysis, esterification, dehydration and Maillard reaction. This work supplies chemical basis for the application of various types of Codonopsis Radix decoction pieces. This article is protected by copyright. All rights reserved.

PMID:35403814 | DOI:10.1002/jssc.202200062

ANZ J Surg. 2022 Apr 11. doi: 10.1111/ans.17700. Online ahead of print.

ABSTRACT

BACKGROUND: Patients presenting for thyroidectomy may have an unrecognized pre-existing vocal cord palsy (VCP). This raises the danger of bilateral VCP if a patient sustains an injury to the RLN on the sole functioning side. Part of the rationale for routine preoperative laryngoscopy is to eliminate such a risk. This paper endeavours to quantify the relevant potential risk.

METHODS: Patients who underwent laryngoscopy prior to thyroid or parathyroid surgery in an endocrine surgical unit over a 5 year period were identified. Literature review revealed four papers in which VCP prevalence in patients without risk factors was reported. Using our data, combined with that of these other authors, the background rate of pre-existing VCP was ascertained, and the subsequent risk of bilateral VCP estimated.

RESULTS: Of our 632 patients who underwent preoperative laryngoscopy, there were four patients (0.63%) who were found to have a unilateral VCP, but all had voice symptoms or previous neck surgery. When patients with these risk factors are excluded, our data combined with the published data provides a pre-existing VCP rate of 0.2%. Calculations estimate that if preoperative laryngoscopy is omitted in patients with no risk factors, the risk of bilateral VCP, due to the nerve on the sole functioning side being injured, would be between 1/50000 and 1/150000, depending on an individual surgeon’s level of experience.

CONCLUSION: Selective use of laryngoscopy prior to thyroidectomy would result in an acceptably low statistical risk of bilateral VCP. Routine laryngoscopy for all patients is not necessary.

PMID:35403799 | DOI:10.1111/ans.17700

Diabetes Obes Metab. 2022 Apr 11. doi: 10.1111/dom.14712. Online ahead of print.

ABSTRACT

AIMS: To assess efficacy, safety and tolerability of cotadutide in patients with type 2 diabetes mellitus and chronic kidney disease (CKD).

MATERIALS AND METHODS: In this phase 2a study (NCT03550378), patients with BMI 25-45 kg/m² , estimated glomerular filtration (eGFR) rate 30-59 mL/min/1.73 m² and type 2 diabetes (HbA1c 6.5-10.5% [48-91 mmol/mol]) controlled with insulin and/or oral therapy combination, were randomized 1:1 to once-daily subcutaneous cotadutide (50-300 μg) or placebo for 32 days. Primary endpoint was plasma glucose concentration assessed using a mixed-meal tolerance test (MMTT).

RESULTS: Participants receiving cotadutide (n = 21) had significant reductions in MMTT area under the glucose concentration-time curve (AUC) (-26.71% vs +3.68%, p < 0.001), more time in target glucose range on continuous glucose monitoring (+14.79% vs -21.23%, p = 0.001) and significant reductions in absolute bodyweight (-3.41 kg vs -0.13 kg, p < 0.001) versus placebo (n = 20). In patients with baseline micro- or macroalbuminuria (n = 18), urinary albumin-to-creatinine ratios (UACR) decreased by 51% at day 32 with cotadutide versus placebo (p = 0.0504). No statistically significant difference was observed in mean change in eGFR between treatments. Mild/ moderate adverse events occurred in 71.4% of participants receiving cotadutide and 35.0% receiving placebo.

CONCLUSIONS: We established the efficacy of cotadutide in this patient population, with significantly improved postprandial glucose control and reduced bodyweight versus placebo. Reductions in UACR suggest potential benefits of cotadutide on kidney function, supporting further evaluation in larger, longer-term clinical trials. This article is protected by copyright. All rights reserved.

PMID:35403793 | DOI:10.1111/dom.14712

J Cosmet Dermatol. 2022 Apr 11. doi: 10.1111/jocd.14984. Online ahead of print.

ABSTRACT

OBJECTIVE: Seborrheic dermatitis (SD) is a chronic inflammatory disease. The etiology of the disease is still unknown. The systemic immune-inflammation index (SII), red cell distribution width (RDW), mean platelet volume (MPV), C-reactive protein (CRP), monocyte to HDL cholesterol ratio (MHR), platelet to lymphocyte ratio (PLR), and neutrophil to lymphocyte ratio (NLR) have all been reported as inflammatory markers in recent studies. However, these inflammatory markers have not been explored in SD patients. This study aimed to explore inflammatory and hematological parameters in SD patients with healthy controls (HCs) and evaluate their possible relationship with disease severity.

MATERIALS AND METHODS: One hundred patients who presented to our hospital and were diagnosed with SD and 74 HCs were retrospectively included in our study. The seborrheic dermatitis area severity index (SDASI) score was used to assess the severity of the SD.

RESULTS: The patient group’s mean PLR, MPV ve CRP levels were statistically significantly higher than the HCs (p < 0.05). There was no statistically significant difference in the patients compared to the control group regarding RDW, NLR, MHR, and SII levels (p > 0.05). There was no statistically significant correlation between NLR, PLR, MPV, Monocyte/HDL cholesterol, SII levels with age, and SDASI in the patient group. There was a significant correlation between CRP with age and RDW with SDASI score.

CONCLUSION: Hematological parameters and CRP are low-cost tests. These tests can be used to define inflammation levels in inflammatory diseases. This study shows that PLR, CRP, and MPV may be used as novel inflammatory markers in SD.

PMID:35403790 | DOI:10.1111/jocd.14984